Volunteers From Religious Congregations Help the Chronically Ill
Faith in Action®, a $90-million program that began in 1983 and extends to 2008, supports interfaith programs to recruit and support volunteer caregivers to help disabled, frail and chronically ill people in their communities. (See Program Results.)

Faith in Action and its predecessor, the Interfaith Volunteer Caregivers Program, established volunteer programs in every state, Puerto Rico and the U.S. Virgin Islands. Volunteers assist elderly and disabled neighbors with meal preparation, shopping and transportation as well as provide a friendly voice on the other end of a telephone and respite for family caregivers.

As described in a review of the program by Paul Jellinek, Terri Gibbs Appel and Terrance Keenan published in the Robert Wood Johnson Anthology (1999, Chapter 7):

Each interfaith coalition is expected to have the following features:

• An authentic interfaith or ecumenical governance, involving a broad spectrum of faiths and denominations working together.
• An average number of 50 volunteers serving 50 persons during the first 12 months of the program.
• Volunteer caregiving that is direct, person-to-person and hands-on and that provides multiple kinds of assistance rather than a single service.

Lessons Learned
The Foundation experience offers lessons about how such voluntarism can improve the life of chronically ill and disabled people and promote community values. It also highlights the challenges to building and sustaining interfaith coalitions focused on volunteer social services.

Two assessments and an evaluation, plus reflections from national program office directors and Foundation staff, articulated the challenges with the program and the lessons learned.

• Have patience. Gaining access to churches and other faith communities was difficult. Programees struggled with getting non-Christian groups and African-American churches to join the interfaith effort. (Vanderbilt Assessment) Interfaith coalitions can work, but they take time. (National Program Office, Generation 2)
• Fundraising. Many of the interfaith coalitions struggled with raising adequate funds. (Vanderbilt Assessment). Projects must start paying attention to fundraising on the day the project starts. (National Program Office, Generation 2)
• Volunteer recruitment. Programees struggled with getting enough volunteers and funds from the participating churches. It was easier to recruit volunteers for occasional activities (e.g., transportation to doctor's visits) than ongoing activities (e.g., regular respite care). (Vanderbilt Assessment)
• Still, volunteers are available. Data from this program do not support the conventional wisdom that would-be volunteers have been lost to the workplace, that volunteer services are limited and of marginal value, or that our litigious society precludes hands-on assistance or transporting a disabled person. (National Program Office, Generation 2)
• Demand is greatest where recruitment is hardest. A major demand for new caregiving services exists in the 40 percent of the country that has the least economic resources and the greatest need for services: inner-city, very rural as well as ethnic minorities. Of the Faith in Action grants reviewed, 19 percent reach the neediest, while 62 percent were located in the 40 percent of the country with arguably the most resources and fewest needs. (George Washington University Assessment)
• Volunteers have a niche in the health care system. Interfaith volunteer caregiver programs fill gaps in the long-term care system (Kenneth Johnson, program director). However, though hundreds of grants have been awarded under the Faith in Action program, "their cumulative impact on the nation's chronic care problem so far is probably marginal at best." (Anthology chapter)
• Hands-on technical assistance is most helpful. Technical assistance provided by the national program office benefits local coalitions, especially when help is provided by people rather than through products. (Public/Private Ventures technical assistance assessment)

Service Credit Banking
In addition to the Faith in Action program, the Foundation supported voluntarism through two national programs and an independent project that fostered the concept of "service credit banking" (SCB), in which volunteers provide services to needy individuals in return for services they receive themselves should the need arise in the future. The service credits earned by volunteers accrue in individual accounts.

The concept was originally developed by Edgar Cahn, an attorney and social activist who came up with the idea of service credits as a way to both provide services to the frail elderly and to connect healthy retired elders with their community.

RWJF supported three service credit banking programs:

• The Service Credit Banking for the Elderly program, a $1.2-million program that ran from 1987 to 1990. It was designed to assist consortia of community groups in six cities to expand service credit banking initiatives. (See the Anthology Volume V, chapter 4.)
• The Cooperative Care Network, a computerized service credit bank in the District on Columbia which the Foundation funded from 1992 to 1995. It failed to meet its participation benchmarks, however, and RWJF did not renew its support. (See Program Results on ID# 019150.)
• The Service Credit Banking in Managed Care program, a $1.5-million program that ran from 1992 to 1999. The program created five service credit banks in for-profit and nonprofit health maintenance organizations. (See Program Results and the Anthology chapter.)
  
  Of the six health maintenance organizations (HMOs) affiliated with the national program, two sites maintained their service credit banks beyond the grant period. (See Program Results for the Rocky Mountain Health Maintenance Organization and CareAmerica Health Plans [now Blue Shield of California]).

Lessons Learned
The lessons below come from authors of the Anthology chapter (2002), which looked at both Service Credit Banking for the Elderly and Service Credit Banking in Managed Care, the Service Credit Banking in Managed Care national program office staff, and project staff members, and Foundation staff. They reflect their views on volunteer programs generally, and service credit banks specifically. They included:

Volunteers

• Not all volunteers possess the temperament for providing one-on-one services for homebound elderly.
• Volunteers often prefer to serve in their own neighborhood or very near home.
• Volunteers were put off by the screening process. Most states required background checks for volunteer programs. The more steps volunteers had to go through, the harder it was to keep them engaged.
• Volunteers often saw themselves as either providers or receivers but not both.
• After a few months' involvement in an SCB program, many volunteers stopped keeping track of their credits. Project staff were frustrated that the total number of volunteer hours was significantly underreported.
• Chronically ill people want to volunteer and can do so. However, identifying and coordinating assignments for volunteers who lacked the physical ability to provide services took staff away from other tasks.

Service Credit Banking

• The projects in Service Credit Banking for the Elderly were effective in attracting people who were volunteering for the first time—not just "stealing" volunteers away from other programs. What's more, the programs had also accomplished a key objective in attracting elderly people to help others their own age. (Judith Feder, Julia Howard and William Scanlon, evaluators of Service Credit Banking for the Elderly, in the Anthology chapter.)
• Two core issues plagued all three projects in Service Credit Banking in Managed Care—a lack of sufficient long-term funding and problems with software to track volunteer time. In addition, most sites struggled with recruiting volunteers, who were generally not motivated by the prospect of banking credits for future use. (Program Results.)
• "Service credits weren't crucial either for attracting volunteers or for keeping them in the program. For example, in a survey that the evaluators conducted, only 13 percent of the volunteers said they were participating in the program to earn credits. By contrast, 64 percent said they were participating 'to help others.'" (Evaluation of Service Credit Banking for the Elderly, Anthology chapter.)
• "In many cases the service credit banking programs weren't doing an especially good job of service credit banking—that is, of keeping track of credits as volunteers accumulated them, or of debiting volunteers' accounts when they cashed them in." (Evaluation of Service Credit Banking for the Elderly, Anthology chapter.)
• Service credit banking organizations had difficulties as organizations. They encountered "trouble recruiting both volunteers and service recipients. They encountered a mismatch between the services older people wanted, like transportation, and the ones that volunteers were willing and able to provide. A sizeable staff was needed to recruit and manage volunteers, maintain their enthusiasm, keep tabs on those who needed services, and run the computer hardware and software that was designed to keep the whole system functioning."
• Because the projects in both programs "didn't generate revenues and usually weren't a core piece of the sponsors' organizational missions, they were viewed as expendable, especially when difficult financial times hit. In fact, within several years after [Service Credit Banking for the Elderly ended], only two of the original projects had survived in something close to their original form." The same was true in Service Credit Banking in Managed Care, where only one program survived. (Anthology chapter and Program Results.)

Conclusions
The Service Credit Banking in Managed Care program did not determine whether earning service credits is a meaningful incentive for volunteers or whether service credit banking programs can produce savings that offset their administrative costs.

Susan Dentzer, reviewing the two service credit banking programs for the RWJF Anthology in 2002 reflected on the potential of service credit banking—also called "time dollars"—to alleviate the growing demand for long-term care services in America:

Nevertheless, some proponents of the service credit concept, according to Dentzer, still believe that despite the track record, service credit programs have a future—to fill a space along the continuum between taxing individuals in order to pay for long-term-care services and freely offering services to one another.